title: Oncological outcomes of metastatic testicular cancers under centralized management through regional medical network.
abstract: OBJECTIVE
  To investigate the dose intensity of induction chemotherapy and oncological outcomes of metastatic testicular cancer under centralized management through a regional medical network.
  
  
  METHODS
  We retrospectively analyzed the outcomes of 86 metastatic testicular cancer patients who were given induction chemotherapy at Tsukuba University Hospital and four branch hospitals between January 2000 and November 2010. Principally, management of patients with poor-prognosis disease and patients having risk factors for bleomycin, etoposide and cisplatin were referred to Tsukuba University Hospital before chemotherapy. For high-risk groups, etoposide and cisplatin or etoposide, ifosfamide and cisplatin was used as an alternative to bleomycin, etoposide and cisplatin.
  
  
  RESULTS
  Overall, 56 and 30 patients were treated at Tsukuba University Hospital and branch hospitals, respectively. Forty-seven, 18 and 21 patients were classified with good-, intermediate- and poor-prognosis disease, respectively, according to the International Germ Cell Cancer Collaborative Group criteria. Eighteen of the 21 patients (86%) with poor-prognosis disease were treated at Tsukuba University Hospital from the beginning of induction chemotherapy. Induction chemotherapy with a high relative dose intensity was possible in most patients. The average relative dose intensity of each drug was >0.96. Treatment procedures other than induction chemotherapy were efficiently centralized; 74% of post-chemotherapy surgery and all second-line or subsequent chemotherapies were performed at Tsukuba University Hospital. The 5-year overall survival rates of the good-, intermediate- and poor-prognosis groups were 97, 93 and 84%, respectively.
  
  
  CONCLUSIONS
  Induction chemotherapy with high relative dose intensity, post-chemotherapy surgery and salvage chemotherapy was accomplished efficiently through centralization of management. Oncological outcomes were excellent, especially in patients with poor-prognosis disease, whose 5-year OS reached 84%.
authors.affiliation: *Department of Urology, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara, Tochigi 329-2763, Japan. hiromu171@yahoo.co.jp.
authors.forename: Hiromu
authors.initials: H
authors.lastname: Inai
authors.forename: Koji
authors.initials: K
authors.lastname: Kawai
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kojima
authors.forename: Akira
authors.initials: A
authors.lastname: Joraku
authors.forename: Toru
authors.initials: T
authors.lastname: Shimazui
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yamauchi
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Miyagawa
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Endo
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Fukuhara
authors.forename: Jun
authors.initials: J
authors.lastname: Miyazaki
authors.forename: Katsunori
authors.initials: K
authors.lastname: Uchida
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nishiyama
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage / Q000009:adverse effects; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D019468:Disease Management; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D005240:Feasibility Studies; D018237:Germinoma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D006785:Hospitals, University; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage / Q000009:adverse effects; D060828:Induction Chemotherapy / Q000379:methods*; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D018239:Seminoma / Q000188:drug therapy / Q000601:surgery; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D001761:Bleomycin; D005047:Etoposide; D002945:Cisplatin; D007069:Ifosfamide
keywords: chemotherapy; outcomes; testicular cancer